A cohesive strategy for alcohol,
narcotic drugs, doping
and tobacco (ANDT) policy
A summarised version of Government Bill 2010/11:47
Article number: S.2011.02, Design and layout: Svensk Information
2
Preface
On 22 December 2010, the Government approved the bill A Cohesive Strategy
for Alcohol, Narcotic Drugs, Doping and Tobacco Policy (En samlad strategi
för alkohol-, narkotika-, dopnings- och tobakspolitiken (prop. 2010/11:47). On
30 March 2011, the Riksdag adopted the bill, and laid down the overall policy
objective for this area : a society free from illegal drugs and doping, with reduced
alcohol-related medical and social harm, and reduced tobacco use. The objective
involves no change in government policy in terms of its perception of the various
substances involved. By adopting a cohesive, integrated approach, the Government aims to clarify its intention to deal with the problems that the use and abuse
of alcohol, narcotic drugs, doping substances and tobacco pose as a whole, both
to the individual and to society at large.
The aim of the overall strategy is to facilitate state management of public support in the ANDT sphere. The strategy establishes the goals, priorities and direction of public measures for the period 2011–2015. It covers a range of areas from
local preventive action to measures designed to limit supply, the fight against
drugs, care and treatment, alcohol and tobacco supervision, and EU and international efforts. Besides the overall objective, the strategy contains seven long-term
objectives of lasting relevance. Linked to these are a number of priority goals to
be achieved during the strategy period, which runs to the end of 2015.
By adopting a five-year cohesive strategy, the Government aims to facilitate a
long-term perspective and better coordination and cooperation between agencies
and other actors. It also wishes to emphasise the responsibility of all actors involved. If the ANDT policy goals are to be achieved in accordance with the strategy,
action will be needed on the part of agencies, municipalities and county councils,
the business community, non-governmental organisations and other sectors of
civil society. The Government takes the view that cooperation between the spheres of health promotion, prevention, crimefighting, treatment and rehabilitation
should be intensified.
The present publication comprises selected excerpts from and a summary of
the Government Bill (2010:11:47) with a view to providing a general picture of
its purpose and content.
Kennert Loheim Kangevik
p.p. The ANDT Secretariat / Ministry of Health and Social Affairs
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Content
Background ....................................................................................... 5
- ANDT policy coordination
- Responsibility of the sectoral agencies in the ANDT policy sphere
The common overall objective of ANDT policy ........... 8
Long-term ANDT policy goals ................................................ 8
Long-term objective #1 ........................................................... 10
Curtailing the supply of illegal drugs, doping substances,
alcohol and tobacco
Long-term objective #2 ........................................................... 12
Protecting children against the harmful effects of alcohol,
narcotic drugs, doping and tobacco
Long-term objective #3 ........................................................... 14
Gradually reducing the number of children and young people
who initiate the use of tobacco, narcotic drugs or doping substances
or begin drinking alcohol early
Long-term objective #4 ........................................................... 17
Gradually reducing the number of people who become involved in
harmful use, abuse or dependence on alcohol, narcotic drugs,
doping substances or tobacco
Long-term objective #5 ........................................................... 19
Improving access by people with abuse or addiction problems to
good quality care and support
Long-term objective #6 ........................................................... 21
Reducing the number of people who die or suffer injuries or damage
to their health as a result of their own or others’ use of alcohol, narcotic drugs,
doping substances or tobacco
Long-term objective #7 ........................................................... 23
Promoting a public health based, restrictive approach to ANDT in the EU
and internationally
Follow-up and evaluation ....................................................... 25
- External evaluation
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Background
A cohesive strategy for alcohol, narcotic drugs, doping
and tobacco policy for the period 2011–2015, adopted
by the Riksdag on 30 March 2011, specifies the goals,
objectives and direction of the Government’s ANDT
policy and sets out national follow-up and evaluation
structures.
The aim of this policy strategy is to facilitate state
management of public support in the ANDT sphere, to
improve coordination and cooperation and to develop
a cohesive view of the common factors underlying the
origins of the problems and their solutions. State governance in the ANDT sphere largely involves specifying
policy direction and goals, providing technical support
and guidelines, and ensuring follow-up and evaluation.
The previous national action plans on alcohol and
narcotic drugs terminated at the end of 2010. The new
structure for following up ANDT policy is based on the
overall objective of a society free of illegal drugs and
doping, with reduced alcohol-related medical and social
harm, and less use of tobacco. Besides this overall objective, there are seven long-term objectives indicating the
direction work is to take, and a number of priority goals
to be achieved before the end of the strategy period.
These goals will serve as a basis for the strategy followup and evaluation process. During the strategy period,
the objective is to establish an appropriate organisational
setup for open comparisons, follow-ups and evaluations of the ANDT strategy goals. Part of this work will
involve submitting proposals for the establishment of
a monitoring and reporting system to accord with the
agreements currently in place in the EU and at international level.
The ANDT strategy will not involve any alteration of
the present allocation of competencies in the Government Offices or between the relevant agencies. The Ministry
of Health and Social Affairs will continue to be responsible for coordinating ANDT policy. The present crosssectoral national and regional structure will remain in
place and be supplemented by a clearly defined structure
for follow-up and evaluation with the aim of facilitating
ANDT coordination and making it more effective.
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REGIONAL LEVEL
NATIONAL LEVEL
GOVERNMENT/PARLIAMENT
Government Offices/
ministries
- ANDT-committee
- ANDT-secretariat
Government agencies
with duties in the
ANDT sphere*
NATIONAL RESPONSIBILITY
ANDT coordination**
NGOs and
value-based organisationst
National Level
** Agency with national role:
The Swedish National Institute of Public Health
is a national knowledge centre and the supervisory
body for the ANDT sphere. Responsible for
strategy and for supporting ANDT coordination.
LOCAL LEVEL
Police authorities,
Swedish Customs Service,
Swedish Coast Guard,
Prison and Probation Service
County Council/
Regional councils
Business sector
Police authorities,
Swedish Customs Service,
Swedish Coast Guard
County Council
County
administrative boards
ANDT coordination
NGOs and valuesbased organisations
Regional Level
County administrative board:
Responsible for the ANDT coordinating
function and for project management
and supervision.
Municipalities
Municipal coordination
NGOs and valuesbased organisations
Local Level
The municipality:
Responsible under the Social Services Act, the
Alcohol Act and the Tobacco Act. Alcohol/tobacco
supervision (where municipalities are responsible).
Local anti-drug programme coordination. School
education and after-school services.
ANDT policy coordination
In the Government Offices the Ministry of Health and
Social Affairs is responsible for ANDT policy coordination. A coordinating function – the ANDT Secretariat –
has accordingly been set up in the ministry.
Another important component of the national
coordinating function is the ANDT Committee, the
Government’s advisory body on alcohol, narcotic drugs,
doping and tobacco issues. The committee has a key
role in spreading awareness of the goals and direction
of government policy in the ANDT sphere. Its work
will be linked more closely to the strategy with a view
to enhancing coordination and cooperation in pursuit
of the seven long-term strategy objectives. The committee will also continue to advise the Government on
ANDT issues and keep it informed on such matters as
research and study findings of relevance to the shaping of
ANDT policy and to strategy implementation, follow-up
and evaluation. The ANDT Secretariat will act as the
committee’s secretariat.
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The National Institute of Public Health, the national knowledge centre for methods and strategies in the
public health sphere, is responsible for cross-sectoral
follow-ups of public health determinants and evaluation
of public health measures.
The institute is also responsible for supporting ANDT
coordinators at Sweden’s county administrative boards.
The boards, which have been tasked with coordinating
preventive work in the ANDT sphere at regional level,
play a key role in the implementation of relevant parts
of the ANDT strategy by linking efforts at local, regional
and national level. The boards, working in collaboration
with the National Institute of Public Health, are required to help relay the Government’s ANDT strategy and
goals via their ANDT coordinators. This coordinating
function should, above all, contribute to the development of structured, long-term, knowledge-based ANDT
initiatives at local level.
Responsibility of the sectoral agencies in the ANDT policy sphere
*Responsibility for the various strands of the
Government’s ANDT policy rests with a number of
national agencies:
Swedish National Institute of Public Health
The Swedish National Institute of Public Health is the
national knowledge centre with responsibility for technical support, methods and strategies in the public health
field. It is responsible for cross-sectoral follow-up of
developments relating to public health determinants, and
for evaluating measures undertaken in the public health
sphere. This includes Target Area 11, Tobacco, Alcohol,
Narcotic Drugs, Doping and Gaming. In addition, the
agency is responsible for national supervision under the
Alcohol Act and the Tobacco Act.
National Board of Health and Welfare
The National Board of Health and Welfare is the national administrative agency responsible for supervising
activities relating to health and medical care and other
medical services, dental care, public health protection,
the prevention and control of communicable diseases,
social services, support and service provision to people
with certain disabilities, and issues relating to alcohol
and substance abuse. The agency is tasked with promoting good health, social welfare and high-quality health
and social care on equal terms for the whole population.
It is also responsible for supervising the social services,
including the substance abuse and addiction care services
and institutions run by the National Board of Institutional Care.
National Agency for Education
As the national administrative body for the Swedish
public school system, the National Agency for Education
is responsible for ensuring that all pupils are afforded the
best possible opportunities to learn and develop.
National Board for Youth Affairs
The National Board for Youth Affairs has overall responsibility for ensuring that national youth policy objectives
are effectively implemented in various sectors of Swedish society. In particular, it is responsible for ensuring
that knowledge and information about young people’s
circumstances and conditions are available, and for disseminating this information at national and local level.
Crime prevention and crimefighting agencies
The National Police Board, the Swedish Prosecution
Authority, the National Economic Crimes Bureau, the
National Tax Board, the Prison and Probation Service,
the Swedish Enforcement Authority, the Swedish Customs Service and the Swedish Coast Guard are responsible for various types of crime prevention and crimefighting work of relevance to ANDT policy.
The Prison and Probation Service provides motivation
therapy and treatment aimed at combating substance
abuse as part of its normal activities.
Swedish Transport Administration and the Swedish Transport Agency
The Swedish Transport Administration and the Swedish
Transport Agency are responsible for road safety matters.
Municipalities and county councils
Medical Products Agency
As the principals for social services and health and medical care respectively, the municipalities and the county
councils are together responsible for the provision of
substance abuse and addiction care services. The municipalities are also responsible for social care provision to
children and young people.
The Medical Products Agency plays an important part in
classifying illegal drugs.
National Board of Institutional Care
The National Board of Institutional Care (SiS) is the
government agency responsible for compulsory care of
young and adult substance abusers.
Swedish Consumer Agency
The Swedish Consumer Agency is the national supervisory agency responsible for overseeing marketing rules
under the Alcohol Act and the Tobacco Act. Its supervisory activities include implementing a range of measures
against deceptive, misleading or unfair practices in the
marketing of alcoholic beverages and tobacco products.
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The common and overall objective
of ANDT policy
The formerly separate alcohol and drugs policy goals and
the general goals for tobacco policy and doping policy
have now been combined into a common overall objective, defined as follows:
A society free from illegal drugs and doping, with
reduced alcohol-related medical and social harm,
and reduced tobacco use.
The objective entails:
• zero tolerance towards illegal drugs and doping,
• measures aimed at reducing all tobacco use and
deterring minors from starting to use tobacco,
• prevention of all harmful consumption of alcohol,
e.g. by reducing consumption and harmful drinking
habits.
The objective reflects the Government’s determination
to tackle the totality of problems caused by the use and
abuse of ANDT for the individual and for society at large. It is based on a vision of a society where all may grow
up, live and work without risking harm through their
own use of alcohol, narcotic drugs, doping substances or
tobacco, or through such use by others. The Government
also wishes to emphasise the principle of shared responsibility. When all contribute, greater progress can be
made. A long-term perspective and increased coordination and cooperation between agencies and other parties
are crucial to success. Also needed is a comprehensive,
integrated approach focused on the individual/user and
the family.
Long-term ANDT policy goals
Overall objective: a society free from illegal drugs and doping, with reduced
alcohol-related medical and social harm, and reduced tobacco use.
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Curtailing the supply of
illegal drugs, doping
substances, alcohol and
tobacco
Protecting children against
the harmful effects of alcohol,
narcotic drugs, doping and
tobacco
Gradually reducing the
number of children and young
people who initiate the use
of tobacco, narcotic drugs or
doping substances or begin
drinking alcohol early
1
2
3
Priority goals
during the strategy period
Priority goals
during the strategy period
Priority goals
during the strategy period
Effective and coordinated
supervision of alcohol and
tobacco
Fewer children born with
harmful or disabling conditions
caused by exposure to alcohol,
narcotic drugs, doping substances or tobacco
Reduced initiation of narcotic
drugs and doping abuse
Effective measures to combat
illicit trading
Effective measures to combat
illicit sales via digital media
Effective local and regional
collaboration and coordination
of ANDT prevention and crime
prevention efforts
Appropriate support for children in families where abuse,
mental illness or mental disability is present
Better knowledge of alcohol
and tobacco marketing practices via digital media, and of
the effect of digital marketing
on consumption
Development of methods for
deterring children and young
people from starting to use
tobacco products
Wider use of available,
effective means of postponing
alcohol debuts and reducing
alcohol consumption
Emphasis on health promotion
in schools
Greater participation by parents, non governmental organisations and the business community in preventive work
Seven long-term objectives
The seven long-term objectives establish the overall
direction of ANDT work. These are rolling objectives
without a set time limit, underpinned by a number of
priority goals to be achieved during the strategy period.
The new goal structure will also serve as a basis for the
follow-up process using national indicators presented by
the Government in the spring of 2011.
Gradually reducing the
number of people who
become involved in harmful
use, abuse or dependence on
alcohol, narcotic drugs,
doping substances or tobacco
Improving access by people
with abuse or addiction
problems to good quality
care and support
Reducing the number of
people who die or suffer
injuries or damage to their
health as a result of their own
or others’ use of alcohol,
narcotic drugs, doping
substances or tobacco
Promoting a public health
based, restrictive approach
to ANDT in the EU and
internationally
4
5
6
7
Priority goals
during the strategy period
Priority goals
during the strategy period
Priority goals
during the strategy period
Priority goals
during the strategy period
Intensified efforts by the
healthcare service to prevent
ANDT-related ill-health (brief
intervention and screening)
Greater access to knowledgebased care and support inputs
Fewer deaths and injuries in
road accidents due to alcohol
or other drugs
Active efforts to ensure
compliance with UN conventions in the narcotic drug field
Fewer deaths and injuries due
to alcohol-related, drug-related
or doping-related violence
Active efforts to ensure
implementation of the EU and
WHO strategies on alcohol and
health
Reduced risk use and less
intensive alcohol consumption
among students and young
adults with mental health
problems
More scope for the dental care
service to focus on tobacco
prevention
Improved opportunities for
the early detection and
prevention of ANDT problems
in working life
A clearer and more
appropriate allocation of
competencies among the
bodies principally responsible
for substance abuse and
addiction care
Reduced disparities in quality,
availability and results at
regional and local level
Lower mortality rate among
teenagers and young adults
due to alcohol poisoning or
drug experimentation
Greater awareness among the
population of the health impact
of ANDT use
Active efforts to ensure compliance with the WHO framework
convention on tobacco control
Active efforts to ensure compliance with UN conventions in
the narcotic drug field
More effective coordination
and increased prioritisation
of Nordic cooperation in the
ANDT sphere
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LONG-TERM OBJECTIVE 1:
Curtailing the supply of illegal drugs,
doping substances, alcohol and tobacco
Curtailing the supply and availability of ANDT is the most effective measure for reducing ANDTrelated harm and abuse. Among other things, this means taking steps to curb the smuggling of
narcotic drugs and doping substances and to reduce all unlawful handling of alcohol and tobacco such as resale and unauthorised sale (peddling).
Retail monopoly and price policy are crucial factors in reducing ANDT-related harm and abuse in
the alcohol field. Age restrictions on the sale of tobacco and alcohol are an important component
of tobacco and alcohol policy.
Priority goals linked to long-term objective 1:
• Effective and coordinated supervision of alcohol and tobacco
One of the most important ways of reducing ANDT-related harm and problems is to restrict supply and availability. A vital part of this endeavour is proper supervision
under the Alcohol and Tobacco acts.
During the strategy period
• county administrative board procedures should be
reviewed with a view to determining how these can
be made more effective and how the ‘test purchase’
method (often referred to as mystery shopping)
might be used in the supervisory process
• the impact of the new provisions in the Alcohol Act
and the Tobacco Act should be evaluated
• efforts to support implementation of effective
methodology in the supervisory process should be
intensified
• public authorities should seek closer cooperation
with the business community
• efforts to strengthen the business sector’s selfmonitoring systems under the Alcohol Act and the
Tobacco Act should continue.
Continued efforts are needed to strengthen supervision,
as noted for instance in the Swedish National Audit Office report, State Support in Alcohol Policy: The effect on
alcohol consumption among young people (Statliga stöd
i alkoholpolitiken – Påverkas ungas alkoholkonsumtion?
Riksrevisionen, 2010). It is essential that supervision of
the provisions on the serving of alcoholic beverages and
10
the sale of beer (ABV 3.5%) and tobacco be efficient and
applied uniformly.
If supervision is to improve further, networks and
coordinating functions developed in recent years must
be maintained. In addition, relevant agencies should
consider ways of stepping up cooperation with the
business community to ensure more effective and better
coordinated supervision. Efforts by the latter to improve
their self-monitoring systems have been successful in
a number of respects. The Responsible Alcohol Serving Practices approach has been widely applied. This
method, which has helped reduce violence in bars, pubs
and restaurants, has proved an important tool in the
supervisory process. This and other similar approaches
that strengthen traders’ self-monitoring functions should
be incorporated into the county administrative boards’
ANDT prevention work, and integrated into their supervisory work.
• Effective measures to combat illicit trading
Illicit trading in ANDT breeds and fuels criminality. Efforts to combat all forms of illicit ANDT trading remain
a priority.
It must be made difficult for young people to obtain
narcotic drugs. Priority should therefore be given to
measures to combat the sale of drugs to children and
young people. Drug abuse often leads to other forms of
criminality and to a criminal lifestyle. It is therefore vital
that steps be taken to combat such abuse among children and young people.
During the strategy period
• crime-fighting agencies should continue their efforts
to curb organised and large-scale crime
• the fight against illegal drugs should continue to be
given high priority, along with action to stop the
organised smuggling and resale of alcohol, tobacco
and substances classed as narcotics (illicit trade).
The transboundary character of serious organised crime
requires close cooperation between relevant agencies
both in Sweden and beyond, as well as active participation in joint international efforts.
• Effective measures to combat illicit sales via
digital media
Illicit ANDT sales via digital media pose a new threat, to
which young people are especially exposed.
During the strategy period
• collaboration on online trading issues should be
intensified
• continued high priority should be given to the classification of new drugs
• efforts should be made to ensure closer collaboration
between relevant authorities with a view to improving surveillance, intelligence work and analysis in
connection with illicit sales.
New ways of obtaining drugs call for new approaches
by the authorities. One area requiring special attention
is the sale of illegal substances via digital media such as
the internet. Studies based on self-reported habits show
that experimenting with narcotic drugs has increased
somewhat among young people in recent years, and
that new drugs have been introduced via the internet.
The Government considers that a faster and more effective classification process targeting new drugs should
be introduced as a matter of priority. In this endeavour,
continuing cooperation between relevant agencies is of
crucial importance.
• Effective local and regional collaboration and
coordination between ANDT prevention and
crime prevention efforts
There is a clear link between alcohol, drugs and doping abuse and criminality. Illicit trading in tobacco is
also practised. Accordingly, concerted action, bringing
together ANDT prevention and crime prevention efforts,
is required at local level.
During the strategy period
• development of working methods and procedures
for strengthening cooperation between ANDT prevention and crime prevention work should continue
• efficient cooperation and coordination between police, schools, social services and other relevant actors
should be given priority at local and regional level
• further efforts should be made to develop longterm cooperation between Malmö, Gothenburg
and Stockholm in the spheres of ANDT and crime
prevention.
It is essential that crime prevention and ANDT prevention work be undertaken locally by those who are most
familiar with the problems prevalent in that community.
Actors such as the police, schools, social services, non
governmental organisations and the business community
have different roles to play. Experience shows that value
is added when local actors, proceeding from their various
roles in the community, join together to prevent crime
and enhance personal security.
National surveys show that Stockholm, Malmö/Skåne
and Gothenburg/Västra Götaland rank high in national
comparisons in terms of the number of drug users per
inhabitant. Increased cooperation on early measures to
reduce the recruitment of new users is therefore vital.
The size of these three cities and their decentralised local
government systems makes coordination a particularly
challenging task.
The three metropolitan areas have requested that
methods applicable to their specific conditions be developed. Further efforts are being made to secure longterm cooperation between the cities on ANDT prevention and crime prevention work.
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LONG-TERM OBJECTIVE 2:
Protecting children against the harmful effects
of alcohol, narcotic drugs, doping and tobacco
Harm to children caused by alcohol, narcotic drugs, doping or tobacco is wholly unacceptable.
Measures to protect children against the harmful use both by themselves and others of alcohol
and tobacco, and the abuse of narcotic drugs and doping substances are fundamental to all
health-promoting and preventive ANDT work.
Under the UN Convention on the Rights of the Child, children are entitled to grow up in a good
environment and enjoy the best possible health. Children are a priority target group both in the
EU and internationally. The Swedish Riksdag has also stressed that children, young people and
their parents are among the most important target groups for preventive and health-promoting
public health efforts and thus for ANDT work as well.
Priority goals linked to long-term objective 2
• Fewer children born with harmful or disabling
conditions caused by alcohol, narcotic drugs,
doping substances or tobacco
Continued efforts are being made to reduce the risk of
children being born with harmful or disabling conditions
caused by the mother’s use of alcohol, narcotic drugs,
doping substances or tobacco during pregnancy.
During the strategy period
• the aim should be to offer expecting parents information and, where necessary, guidance on the
harmful effects of ANDT
• parents with a risk profile or abuse problem should
be given appropriate support or care so that the
child is not harmed
• care and support provision both for children born
with harmful conditions caused by ANDT and for
their parents should be improved
• efforts should be made to gain more precise knowledge of how many children are born with harmful
conditions caused by ANDT and of their development prognosis.
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The aim is to gradually reduce all adverse effects of
ANDT on unborn children. Supportive and awarenessraising initiatives targeting expecting parents and focusing on the harmful effects of ANDT during pregnancy
and breast-feeding are to be given priority.
For many years, the maternity care service has striven
successfully to prevent ANDT-related harm during pregnancy. Training courses for doctors and midwives have
been an important element here and it is vital that such
training continue to receive support. Expecting parents
have a right to information and guidance on the risks
associated with ANDT. It is essential, therefore, that the
present network for maternity care and child healthcare
services be maintained.
More knowledge is needed regarding the number of
children born with Fetal Alcohol Syndrome (FAS) or
Fetal Alcohol Spectrum Disorders (FASD) and whether
they are receiving adequate care and treatment. To better
enable parents to provide children with a good environment to grow up in, support should be maintained for as
long as necessary.
Support to pregnant women with an abuse problem
or addiction needs to be stepped up. Pregnant women
with an ongoing abuse problem must be given appropriate support and treatment to help them become drugfree.
• Appropriate support for children in families
where abuse, mental illness or mental disability
is present
There must be greater awareness that children in families where abuse, mental illness or mental disability is
present may require special support from bodies responsible for dealing with these children. Staff encountering
parents with problems of this nature must be aware both
of their obligations and of the various support measures
available.
During the strategy period
• the new provisions in the Health and Medical Services Act and the Patient Safety Act should be duly
applied and all county councils should lay down procedures governing the responsibilities and authority
of service providers
• support for children living in families where abuse,
mental illness or mental disability is present should
be further developed
• local cooperation should be improved among professional groups and activities dealing with children
who suffer neglect or mistreatment or are at risk of
neglect or mistreatment due to their own risk use or
abuse, or that of others
• steps should be taken at national level to ensure that
municipalities’ preventive work with children in
need of special support is regularly reviewed.
Measures on behalf of children in families where abuse,
mental illness or mental disability is present are warranted. Children must never be left in vulnerable situations
without a supportive response from the community.
Moreover, public action reduces the risk of vulnerable
children and young people being exposed to mental
problems and substance abuse problems of their own in
later life. To ensure that each individual child at risk receives support, better means of identifying and reaching
such children and their families must be developed.
Professional groups required by law to notify the
social services must have the necessary knowledge and
procedures to identify and attend to children in families
with abuse problems, and know what kind of help is
available to them. Cooperation between relevant bodies
is essential. Collaboration between the various actors
dealing with vulnerable children, with their parents and
with other important persons in their vicinity has been
a success. The National Board of Health and Welfare has
drawn up a guidance on effective cooperation in this
sphere. This material should be disseminated and used
by the social services and other actors providing care and
support to children, young people and parents.
On 1 January 2010, new provisions were introduced
into the Health and Medical Services Act and the Health
and Medical Services (Professional Activities) Act. A
similar provision was added to the Patient Safety Act on
1 January 2011. The laws were amended to take account
of cases where parents or guardians living with the child
suffer from mental illness/impairments or have a substance abuse problem. The healthcare service needs to
develop a child- and family-oriented approach, and close
cooperation is essential between adult psychiatric care,
primary care, child and adolescent psychiatric care, social
services, schools and other relevant actors.
• Better knowledge of alcohol and tobacco
marketing practices via digital media, and of the
effect of digital marketing on consumption
The marketing of alcohol and tobacco is increasingly
being channelled through new media, such as digital
media. A summary of research findings to date shows
that there is a link between exposure and consumption
by young people.
During the strategy period
• a survey should be conducted charting the scale and
scope of alcohol and tobacco marketing in digital
media
• data on international research in this field should be
compiled
• monitoring methods should be proposed that will
enable supervisory authorities to rapidly trace and
act against breaches of marketing legislation.
At Sweden’s initiative, the EU health ministers adopted
Council conclusions on alcohol and health during the
Swedish presidency in 2009. The conclusions urge the
European Commission to consider further action to
protect children and young people from the marketing
of alcohol. Sweden will monitor the outcome when the
Commission delivers its report on implementation of the
EU alcohol strategy in 2012.
The extent of alcohol and tobacco marketing via digital media, how this marketing impacts consumption and
how supervision can be made more effective all need to
be examined. The aim is to develop a basis for effective
supervision of alcohol and tobacco marketing via digital
media and TV broadcasting from abroad.
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LONG-TERM OBJECTIVE 3:
Gradually reducing the number of children and young
people who initiate the use of tobacco, narcotic drugs
or doping substances or begin drinking alcohol early
Higher priority should be given to measures aimed at preventing young people from starting to
use narcotic drugs or doping substances or from starting to drink alcohol at an early age. The
prospects of changing behaviour patterns and norms are greater if measures are taken in a number of different areas and by actors working together. Parents, schools, the recreational sector,
the social services, the police, non governmental organisations and the business community all
have important roles to play in prevention work.
Measures aimed at limiting supply/availability, such as age checks, the presence of police or
parents and effective supervision, are crucial to the task of postponing the debut age for alcohol
and tobacco use and initiation of drug and doping abuse. Moreover, children’s perceptions and
future habits are significantly affected by the norms and values of parents and other adults and
by their ability to set limits and define the boundaries of acceptable behaviour.
Action is also needed to raise awareness and reduce demand. It is important to influence attitudes and encourage acceptance of restrictive ANDT policies. Awareness of the impact of ANDT on
health, criminality and social development is also important.
The structure developed at regional and local level for coordinating action, improving professional skills and applying knowledge-based methods is crucial to the achievement of this long-term
objective.
Priority goals linked to long-term objective 3:
• Reduced initiation of narcotic drugs and doping abuse
Experimentation with narcotics and other drugs is on
the rise among young people, and a growing number are
being exposed to these substances. Stronger measures
to prevent initiation of drug abuse should therefore be
given high priority.
During the strategy period
• coordinated efforts to facilitate early detection
should be strengthened at local level
• support to the ‘Krogar mot knark’ anti-drug network
for bars, pubs and restaurants should continue
• methods should be developed to improve the
monitoring of particularly vulnerable groups and of
certain geographical areas
• methods should be developed to improve monitoring of new drugs and attendant marketing activities
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• efforts should be made to develop methods aimed
at enhancing knowledge and improving coordination
between actors in the fight against doping abuse in
society.
There are indications that hashish and marijuana are
gaining acceptance in certain youth groups and among
young adults. The percentage of school pupils who
report that they have used cannabis at some point has
increased slightly, and the follow-up by the National
Institute of Public Health of the previous national action
plan against narcotic drugs also shows that prevention
work has lost some momentum in recent years. These
developments underline the need to step up preventive
efforts in the narcotic drugs and doping sphere.
Continued active support within the framework of
the national anti-drug network ‘Krogar mot knark’ affords vital access to experimental abuse found in bars,
pubs, restaurants and other places of entertainment,
particularly in metropolitan areas.
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An anti-doping network, PRO-DIS, has been set up
in Sweden to develop and evaluate a working model
designed to prevent the use of anabolic androgen steroids (AAS). It is important to ensure that this network
for the exchange of experience and skills continues to
function.
• Development of methods for deterring children
and young people from starting to use tobacco
products
An interim goal of Sweden’s tobacco policy is to halve
the number of children and young people who start
smoking or taking snuff before the age of 18, by the
year 2014. To reach this goal, tobacco prevention work
among children and young people will need to be given
priority and become more target group-oriented.
During the strategy period
• efforts should be made to develop methods for deriving measures to deter children and young people
from starting to use tobacco
• efforts should be made to develop methods for deriving early measures for dealing with those who have
begun to smoke or take snuff
• efforts to ensure compliance with the rules on
smoke-free environments should be stepped up.
Tobacco consumption is one of the most serious threats
to public health. Young people are the most important
target group since the great majority begin smoking in
their teens. Every day, some 50 young people in Sweden
start using tobacco. This corresponds to approximately
16 000 per year.
Although the disparity in tobacco use among boys
and girls has narrowed, there are still twice as many daily
smokers among girls as among boys in the 15-year age
group. Targeted preventive measures for dealing with
tobacco use among girls and boys need to be developed,
along with support measures to help young people to
stop smoking.
Smoke-free environments are needed to help reduce
exposure of young people to tobacco use. Also important
in this connection are better compliance with statutory
provisions such as the Tobacco Act’s ban on the sale of
tobacco to minors, the ban on tobacco marketing and the
provisions governing smoke-free schoolyards.
Measures aimed at influencing adult values and habits
are also essential to reducing tobacco consumption
among the young.
Information about the harmful effects of tobacco
must be framed so that it also reaches those who may
begin using tobacco – not just those who have already
begun.
Interest in smoking hookahs [water pipe] has increased among young people. One boy in three and one
girl in four aged 15 has smoked a hookah at some point,
as have some two thirds of all boys and girls aged 17.
The level of awareness of the harmful effects of hookah
smoking is relatively low. Every time someone smokes a
hookah she/he consumes a variety of carcinogenic substances. The use of hookahs, must therefore be included
in tobacco prevention work.
• Wider use of available, effective means of
postponing alcohol debuts and reducing alcohol
consumption
The percentage of alcohol consumers among 15-yearolds has declined since 2004. The same is true of the
proportion who report intensive consumption of alcohol.
There is wide agreement today among those actively
involved with the issue on the best ways of reducing alcohol consumption among minors and harmful drinking
among young adults.
During the strategy period
• efforts to reduce illegal sales (peddling) should continue
• efforts to further improve compliance with statutory
age limits should continue
• efforts should be made to attenuate the link between sport and alcohol
• steps should be taken to make people more aware of
the importance of an alcohol-free upbringing.
Effective ways of countering harmful drinking patterns
among minors and young adults should be used more
widely. This includes methods for ensuring compliance
with age restrictions, and preventing peddling. In addition, more effective ways are needed to reach minors and
young adults with high consumption rates.
One of the most important measures for preventing drinking among minors and raising the debut age
is action against peddling, i.e. the practice of someone
unlawfully buying alcohol for, or selling or giving it to, a
person under 20 years of age.
The police actively engage in preventive efforts to
stop peddlers making alcohol available to minors. One
of the methods used in this connection is the Kronoberg Model. By stopping peddling and limiting alcohol
consumption by minors in public places, the model has
successfully reduced alcohol-related criminal violence.
This and other well-tried approaches should be used
more widely.
Continued long-term efforts are needed to maintain
compliance with statutory age limits for the sale and serving of alcohol. Systembolaget (the Swedish Alcohol Re15
tail Monopoly) engages in important and effective work
to prevent sales to minors through the use of age checks
and information campaigns stressing the importance of
not supplying under-age people with alcohol. Similar
measures are being applied in bars, pubs and restaurants,
e.g. by applying tried and tested Responsible Alcohol
Serving practices, aimed at preventing the serving of
alcoholic beverages to minors in these environments.
Success depends on operators tightening controls themselves, for instance by teaching staff about the provisions
of the Alcohol Act. The same applies to the retailing of
beer (ABV 3.5%).
Non governmental organisations have an important
role to play in educating public opinion on the dangers
of alcohol consumption at a young age. Youth organisations and the sports movement are both active in the
fight against peddling. However, the Government would
welcome a broader approach; a number of studies have
shown that young people who engage in sports and/or
are active in a sports organisation do not drink any less
than others. The sports movement, therefore, needs to
take up a position on the effects of alcohol at club and
association level.
• Emphasis on health promotion in schools
Success and enjoyment at school are important health
protection factors for children and teenagers. By laying
emphasis on health promotion work, schools can help
prevent and combat ANDT in the long term.
During the strategy period
• compulsory schools and upper secondary schools
should be given access to training to help develop tuition in alcohol, narcotic drugs, doping and
tobacco. Such training is to be based on research and
proven experience.
The National Agency for Education has taken a number
of steps to promote long-term preventive efforts in this
field. These have focused for instance on strengthening
school work on basic values, abusive behaviour and gender equality. Such efforts should now be supplemented
by training initiatives centring on alcohol, narcotic drugs,
doping and tobacco. The National Agency for Education
has been tasked with promoting both school improvement in general and ANDT tuition.
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• Greater participation by parents, non governmental organisations and the business community in preventive work
It is essential that parents, non governmental organisations and the business community be committed to and
take an active part in prevention work.
During the strategy period
• government agencies, municipalities, county councils
and non governmental organisations should deepen
their cooperation and collaboration and the number
of joint activities should increase
• there should be continued dialogue between the Government, agencies and non governmental organisations
• a dialogue should be launched with the business
community to encourage the development of further
initiatives by business enterprises and improve
self-monitoring pursuant to current legislation and
voluntary codes.
A good, secure upbringing is crucial to the health of
children and young people in later life. There is a link
between mental ill-health and a heightened risk of substance abuse. Positive interaction between children and
parents reduces the risk of mental ill-health and future
abuse.
Parental support should be offered to all parents until
the child reaches the age of 18. Preventive support to
parents enhances both health and positive development
in children and makes them more resilient to ill-health
and social problems. In practice, the risk factors for
abuse, mental ill-health and anti-social behaviour are one
and the same. Parental support, therefore, is also important for ANDT prevention.
With their expertise and experience, non governmental organisations are vital cogs in preventive work. They
also offer a wide range of support activities.
The aim during the strategy period is for all municipalities to have created a structure and a plan for ongoing
cooperation and collaboration with non governmental
organisations.
Continued dialogue between the Government, agencies and non governmental organisations is crucial to the
implementation of the ANDT strategy.
During the strategy period the Government and the
business community should engage in dialogue aimed
at encouraging the development of further initiatives
by operators and improving company self-monitoring
pursuant to current legislation.
LONG-TERM OBJECTIVE 4:
Gradually reducing the number of people who become
involved in harmful use, abuse or dependence on
alcohol, narcotic drugs, doping substances or tobacco
By ensuring early identification and support aimed at changing harmful and risky lifestyles, society can help protect individuals, families and those around them from harm, while at the same
time contributing to favourable economic, social and more health-oriented community development. Important arenas for screening and brief interventions are the regular healthcare sector,
occupational healthcare, dental care and higher education institutions.
Priority goals linked to with long-term objective 4:
• Intensified efforts by the healthcare service to
prevent ANDT-related ill-health
Although county councils have an explicit responsibility
to prevent disease under the Health and Medical Services Act, the principle of prevention has not yet become
fully recognised and adopted within the healthcare
service.
During the strategy period
• the healthcare service should integrate the disease
prevention perspective into its regular operations,
which calls for measures to prevent tobacco use and
the risk use of alcohol, and counter the abuse of
narcotic drugs and doping substances.
• the National Board of Health and Welfare’s national
guidelines for preventive work in the tobacco and
alcohol spheres should be disseminated and applied
in the healthcare sector.
The National Board of Health and Welfare guidelines
for health-promotion and prevention work – which also
cover tobacco and alcohol – may be an aid in this context. The guidelines will be formally adopted in 2011. If
they are to become an effective instrument, the healthcare service must actively learn from them and seek to
ensure that they are fully applied in practice. This will
entail measures such as basic training courses and further
training. It is important that the experience and skills
acquired in the course of the Risk Consumption Project
should be turned to account when implementing the
guidelines.
• Reduced risk use and less intensive consumption of alcohol among students and young adults
with mental health problems
Young adults (aged 18–25) have the highest rate of
alcohol consumption. Almost half the members of this
age group are students at higher education institutions,
which are therefore important arenas for ANDT action.
Continued national support for the development of skills
and methodology is crucial to ensuring long-term, active
commitment to student health in particular.
During the strategy period
• technical and capacity building support to student
health clinics that offer healthcare to students
should be continued
• coordinated support should be provided for the
development of skills and methodology relating to
ANDT prevention work by the student health service
• primary care, the psychiatric service and the student
health service should intensify efforts to reach young
adults in the process of developing risk use habits.
Studies show that young people increase their alcohol
consumption when they begin studying at higher education institutions. The National Institute of Public Health
has shown that there is a strong link between mental illhealth and high levels of alcohol consumption. This link
is most evident in young men.
There are now many points of entry for healthcare
provision to teenagers and young adults. These include
17
youth clinics/youth health services, primary care, the
psychiatric service and the student health service. These
services are all uniquely placed to identify people showing incipient high-risk use patterns.
The ability to identify such people at an early stage
should be further developed. One effective method is
motivational counselling. This approach should be disseminated more widely in the healthcare service.
The efforts currently under way to coordinate support
for the development of skills and methodology in connection with the student health service’s ANDT prevention work should continue.
• More scope for the dental care service to focus
on tobacco prevention
The dental care service is well placed to engage in tobacco prevention work.
During the strategy period
• the dental care service should become better equipped to deal with tobacco prevention, e.g. through
more training input.
The dental care service regularly encounters all children
and young people in Sweden as well as most adults. It is
thus well placed to identify risk behaviour and influence
norms. It is also experienced in helping patients correct
harmful behaviour. The service is frequently in touch
with patients before they start using tobacco or before
they experience symptoms, which means preventive
work is possible from an early stage.
• Improved opportunities for early detection and
prevention of ANDT problems in working life
The occupational healthcare service, workplaces and unions can all help ensure that risk consumption and abuse
are detected early on and that support mechanisms are
put in place.
During the strategy period
• more workplaces should adopt and implement
ANDT-based policy measures featuring guidelines
for support and treatment of employees with risk
use and abuse problems and for efficient collaboration between employers and union representatives
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• national skills support provision should continue in
order to ensure that the risk use model is maintained
• methods for the early identification and prevention
of alcohol and drug problems should be disseminated more widely
• dialogue with relevant parties should be initiated
with a view to identifying workplace needs for support and training in ANDT-related issues
• research should be initiated on the relationship
between ANDT use and absence through illness and
accidents at the workplace.
Workplaces and the occupational healthcare service
should be given a more prominent role in pursuit of the
ANDT policy objectives. It is estimated that about a
fifth of the material costs of alcohol consumption arise in
working life (accidents, sickness absence, unemployment,
production losses etc). Despite the link between ANDT
use and absence through illness, the impact of harmful
alcohol consumption on working life is a relatively unexplored field of research in Sweden. Such research needs
to be stepped up.
Early detection of alcohol and drug problems reduces
both personal suffering and the costs incurred by the
company and society at large. For those whose consumption has reached a risk threshold but who have yet to
experience problems, information about where to draw
the line can have the desired effect. Evaluations have
shown that brief discussions on alcohol issues between
doctors and patients are highly effective.
The National Institute of Public Health was commissioned to enhance professional skills in the occupational
health service as part of the former national Risk Use
Project. Continuing national support for skills enhancement programmes is needed to maintain preventive,
early measures at workplaces.
Dialogue should be initiated with the occupational
health service, relevant agencies and unions, representatives of the research community and other experts with
the aim of identifying workplace needs and carrying
forward work on counselling, support and training in
ANDT-related issues.
LONG-TERM OBJECTIVE 5:
Improving access by people with alcohol and drug-use
disorders and other conditions caused by harmful use
of alcohol and drugs to good quality care and support
Greater access to measures adapted to the needs of target groups, long-term emphasis on consistent good quality care throughout the country, and care provision centred on the needs of the
individual is essential if the abuse and addiction care objectives are to be achieved. People who
are motivated must receive care and support, and all must be treated with respect.
Greater user influence and control over measures taken by users as well as measures taken at
operational level are important prerequisites for securing good quality care.
Public action against drug, doping and alcohol abuse must be based on an integrated approach
that incorporates the work of the social services, the National Board of Institutional Care, the
healthcare service and the Prison and Probation Service in this sphere. The aim is to encourage
long-term, effective cooperation focused on the individual and his or her family. In cases where
children are involved, it is important to allow the child a say in the process.
Priority goals linked to long-term objective 5:
• Greater access to knowledge-based care and
support inputs
Care, treatment and rehabilitation are the basis for
helping people with alcohol and drug-use disorders and
other conditions caused by harmful use of alcohol and
drugs. Existing knowledge must be applied, but knowledge and skills development and greater user influence
are also crucial to the achievement of good quality
needs-based abuse and addiction care.
During the strategy period
• continued development of knowledge and methods
should be given priority, and the skills required by
those working in substance abuse and addiction care
should be more fully specified
• greater priority should be given to ensuring that
those who have difficulty obtaining the care they
need – e.g. people experiencing comorbidity – are
offered such care.
• support and care provision specially adapted for
women should be further developed
• efforts should be made to develop ways of profiting
from users’ own experience.
The National Board of Health and Welfare’s national
guidelines on substance abuse and addiction care also
address the activities of the social services, the National
Board of Institutional Care, the healthcare service and
the Prison and Probation Service. The guidelines provide
a basis for a more knowledge-based care service.
The Government and the Swedish Association of
Local Authorities and Regions have entered into annual
agreements on support to municipalities and county
councils for guidelines implementation and the development of a more long-term structure for knowledge
management. Encouraging further knowledge and skills
development and ensuring that current awareness of
effective methods is translated into practical action are
both important prerequisites for high-quality abuse and
addiction care provision.
Among those receiving care and treatment for mental
illness or mental disabilities are a large group of people
with comorbidity. Women’s organisations have noted a
rise in alcohol and pharmaceutical drug abuse, especially among women. This underlines the present lack of
measures and care provision specifically targeting young
women. Support and care adapted to women’s needs
must be made available to women of all ages.
User experience is an important source of knowledge
when care services develop their policies and practices.
Ways and means of turning users’ experience to account
must be developed.
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• A clearer and more appropriate allocation of
competencies between the principals responsible for substance abuse and addiction care
Principals’ responsibilities must be clearly defined, and
the healthcare service, the social services and other
actors must coordinate their efforts based on the needs
of the individual.
During the strategy period
• the National Board of Health and Welfare’s regulations and general recommendations on healthcare
and social service provision should be brought
together in a common set of rules
• there should be closer collaboration between the
various links in the care chain.
Principals in the substance abuse and addiction care
sphere have responsibilities under various laws. Municipalities and county councils each have responsibility
for key links in this care chain, including sobering-up,
withdrawal and treatment. People in need of abuse or
addiction care often require simultaneous treatment
from different service providers. Providers’ responsibilities for the various parts of the care chain and for various
target groups therefore need to be clarified.
The Government has appointed an inquiry
(S2008:04) to review substance abuse and addiction care
as a whole. This inquiry is to consider the need for changes in legislation and in the allocation of competencies
between the two main principles with the aim of ensuring that people with abuse or dependence problems
receive the care and support they need.
A further measure is the revision of the National
Board of Health and Welfare’s current regulations and
general recommendations on quality assurance management in the healthcare service and the social services.
The aim is to merge the formerly separate regulations
and recommendations governing the healthcare service
and social services respectively into a single, uniform set
of rules.
The Prison and Probation Service is also part of the
substance abuse and addiction care chain. The agency is
required, along with other agencies to strive to ensure
20
that the inmate’s needs are met as far as possible, without thereby diminishing the latter’s own responsibility.
It is further charged with facilitating and supporting
communication between prison inmates and the relevant agencies. Cooperation primarily with the social
services, the healthcare service, the public employment
offices and social insurance offices needs to be intensified
further during the strategy period.
• Reduced disparities in quality, availability and
results at regional and local level
Effective supervision and access to open comparisons are
important tools for ensuring consistent substance abuse
and addiction care throughout the country.
During the strategy period
• action to ensure efficient supervision should be given
priority
• the work currently under way to develop open
comparisons in the abuse and addiction care service
should be completed in order to promote quality development and ensure better access to care on equal
terms.
The National Board of Health and Welfare’s open comparisons in the abuse and addiction care field show that
there are local and regional disparities in access to care
measures. Thus the chances of having one’s care needs
properly met depends on where in the country one lives.
Continued development of effective supervision
capable of showing how well the needs of children and
other family members are being met and how user participation is being assured is crucial to achieving greater
uniformity in care provision and to provision based on
the specific needs of the individual. Efforts to develop
effective supervision must be given high priority.
The publication of open comparisons in the field of
substance abuse and addiction care makes it possible
to monitor, support and improve quality. In 2014, open
comparisons adapted to specific target groups will become available. Decision-makers and users alike should
be able to access information about quality and results.
LONG-TERM OBJECTIVE 6:
Reducing the number of people who die or suffer
injuries or damage to their health as a result of their
own or others’ use of alcohol, narcotic drugs, doping
substances or tobacco
A significant percentage of injuries and premature deaths in Sweden are due to the harmful use
and abuse of alcohol, narcotic drugs, doping substances and tobacco. These are also responsible
for an unacceptably large share of the total disease burden and have strong statistical links to
criminality and violence. The young are particularly vulnerable. Reducing the number of deaths
and injuries due to ANDT is a self-evident, long-term policy goal.
There is a well-established link between the extent of alcohol, drug and doping use on the one
hand and the prevalence of violence and accidents on the other. Common crime categories are
assault and driving under the influence following the consumption of alcohol or drugs. Drivers
intoxicated on alcohol are involved in some 15 per cent of all fatal road accidents.
Achieving the long-term objective will mean prioritising measures aimed at reducing substance
abuse and ANDT-related violence in public places. Greater attention should also be focused on
ANDT-related violence within the family.
Priority goals associated with long-term objective 6:
• Fewer deaths and injuries in road accidents
due to alcohol or other drugs
Every year, drivers under the influence of alcohol cause
numerous road accidents resulting in death or serious
injury. A wide range of measures is required to combat
drink-driving, including a carefully considered strategy
for applying a raft of high-quality alcohol and drug
control mechanisms, harmonised information efforts, the
continued phasing-in of ‘alcolocks’ both for drink-driving
offenders and for preventive purposes, and measures that
facilitate the prevention, detection and investigation of
drink-driving offences.
During the strategy period
• development of structures for cooperation between
police authorities, municipalities, addiction care
services, county administrative boards and transport
authorities should continue
• the use of alcolocks and similar technology to prevent drivers from driving their vehicles should be
stepped up
• traffic statistics should become more reliable and
comparable over time, and more data should be
gathered on the extent of drink-driving and of drug
use by drivers.
Drink-driving is one of the principal causes of fatal road
accidents: 21 per cent of all those who die in traffic accidents are drivers under the influence of alcohol. Drivers
under the influence of narcotic drugs, doping substances
and pharmaceuticals pose a growing problem on the
roads.
In order to achieve the ‘zero vision’ in road use – no
deaths or serious injuries in the future – as well as the
present priority goal, reliable statistics that are comparable over time are needed to help the authorities decide
what action is required.
Achieving the long-term objective: Fewer deaths and
injuries due to the use of ANDT, will call for continuing
efforts to detect intoxicated drivers and to offer them
support and treatment. It will also necessitate the further
development of structures for cooperation between
agencies – such as the police authorities, municipalities,
addiction care services, county administrative boards and
21
the Swedish Transport Administration – on the lines of
the programme: Cooperation Against Alcohol and Drugs
in Road Traffic, or other, similar approach. Where such
programmes are already in place, these should be further
refined on the basis of existing experience, and procedures should be coordinated.
The use of alcolocks should be stepped up during the
strategy period. The Government has introduced a regulation requiring all government authorities to fit their
vehicles with such locks. Many employers have also installed alcolocks in their vehicles as a voluntary measure.
This development should be encouraged.
The rules against operating a boat under the influence
of alcohol were tightened up on 1 June 2010. Information measures need to be introduced during the strategy
period to raise awareness of these rules.
• Fewer deaths and injuries due to alcohol-related, drug-related or doping-related violence
There is a clear link between intoxication from alcohol,
drugs or doping and crimes of violence. The influence
of alcohol, in combination with other factors, can also
increase vulnerability to crime.
During the strategy period
• efforts should be made to gain a better understanding of the extent and character of alcohol-, drugand doping-related violence
• knowledge-based working methods for reducing this
type of violent crime should be disseminated more
widely.
More needs to be known about alcohol-related, drugrelated and doping-related violence. It is also vital to
reach people with abuse problems so they can receive
the support and assistance they need to overcome their
addiction. At the same time, people must feel secure in
public places. Measures targeting youth environments
should be introduced through close cooperation between
the police and the entertainment industry. This should
include extensive supervision to ensure that the rules on
serving alcohol are observed.
The police authorities apply a range of methods
to reduce youth violence in public places. One is the
Kronoberg Model, which is aimed at reducing criminally
violent behaviour among young people by restricting
their consumption of alcohol. This method and other
similar, tried and tested methods should be disseminated
more widely.
22
• Lower mortality rate among teenagers and
young adults due to alcohol poisoning or drug
experimentation
More in-depth knowledge and rapid analyses are needed
so that authorities can better monitor developments and
action aimed at lowering youth mortality rates induced
by alcohol, narcotic drugs, doping substances or tobacco.
Particular emphasis should be given to measures designed to reduce mortality from to alcohol, drugs and
doping.
During the strategy period
• efforts should be made to gain a closer understanding of the underlying causes of acute fatalities
• procedures for cooperation between emergency care
and abuse and addiction care should be improved.
Most cases of alcohol poisoning occur in the 20–24 age
group. This applies to both women and men. Cannabisrelated deaths show a very different profile to deaths
from other illegal drugs. Here we find cases of violent
and impulsive suicide.
A new hazard has emerged in the form of so-called
designer drugs sold over the internet, the contents of
which are often unknown to the buyer. As interest in
these drugs spreads, growing numbers of people are at
risk of coming to harm. The healthcare service, in particular the emergency medical care service, must therefore
learn more about how such cases are to be identified
and diagnosed as well as about the underlying causes
of acute fatalities. The healthcare service is developing
measures and collaborative procedures for dealing with
people brought in for treatment for abuse of GHB
[Gamma-Hydroxybutyric acid] and GBL [Gamma
Butyrolactone]. The procedures for cooperation between
the emergency care and the abuse and addiction care
services need to be improved in such cases. Knowledge
and experience gained in the course of this work should
be used to improve the care and treatment of people
harmed by designer drugs and other hazardous substances.
• Greater awareness among the population of
the health impact of ANDT use
Measures targeting the population as a whole are needed
if the harmful effects of ANDT are to be properly understood and support for current ANDT legislation is to
be maintained.
During the strategy period
• new research findings on the impact of ANDT on
health should be disseminated to the general public.
In 2009, Eurostat published a special Eurobarometer on
the attitudes of EU citizens to alcohol. The study shows
that Swedish citizens are less aware of the link between
high alcohol consumption and (for example) cancer than
other EU citizens. Despite police reports that marijuana (for example) is now more widely accepted, new
research shows that even small amounts of cannabis can
have serious effects in the form of learning problems
and identity disturbances. The effects of tobacco are well
known, yet tobacco consumption remains high among
certain groups, including girls, young women and people
with disabilities.
The aim during the strategy period should be to introduce innovative and target group-oriented measures to
enhance public awareness of the adverse health effects of
ANDT.
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LONG-TERM OBJECTIVE 7:
Promoting a public health based, restrictive
approach to ANDT in the EU and internationally
Sweden is dependent on and is increasingly influenced by the world around it. It is therefore essential that ANDT policy issues be actively pursued both within the EU and in other international forums. Sweden must strive to uphold respect for internationally adopted strategies and conventions.
This means that Sweden must also live up to commitments made under international agreements
and treaties.
The long-term objective is to help bring about a public health based, restrictive approach to ANDT
at international level.
Active participation, especially in the work of the EU, is crucial both to the achievement of the
national ANDT policy objectives and to delivery of the commitments Sweden has made in the ANDT
sphere within the EU and internationally.
Priority goals linked to long-term objective 7:
• Active efforts to ensure compliance with UN
conventions in the narcotic drugs sphere
Well-developed international cooperation is essential if
the fight against narcotic drugs is to be effective.
During the strategy period
• An inquiry chair should be appointed to review
Sweden’s international commitments and to a)
submit proposals as to how Sweden can help ensure
continued respect for the UN conventions on illegal
drugs, and b) propose option on how resources might be better used and coordinated. The committee’s
proposals will be dealt with during the strategy
period.
It is important to create conditions conducive to full
exploitation of international forms of cooperation in
the fight against narcotic drugs and to ensure that they
become a part of the regular operations of the agencies
responsible for fighting crime.
Young people are influenced not only by their local
environment and their upbringing, but also by cultures
and norms of a more general, transboundary nature.
Both the internet and social media are important factors
in this connection. The internet is not only a source of
information but also a market for the sale of goods and
services, including medicines and drugs. Control systems
24
are circumvented and a wide range of drugs are offered
for sale. Creative and aggressive marketing methods have
become increasingly common.
• Active efforts to ensure implementation of the
EU and WHO strategies on alcohol and health
Sweden is committed to participating in the task of
reducing alcohol-related harm within the EU and internationally.
During the strategy period, Sweden should
• actively seek both implementation of the EU strategy to support member states in reducing alcohol
related harm and implementation of the goals and
guiding principles of the Global Alcohol Strategy.
• take part in the efforts of the WHO European
Region to develop an implementation plan for the
Global Alcohol Strategy.
In 2006, the EU adopted a common strategy for the
reduction of the harmful effects of alcohol. Sweden and
the other member states have pledged to participate in
the work of reducing alcohol-related harm at both national level and EU level. During the Swedish presidency in 2009, Council conclusions were adopted urging
the Commission to deliver a final report on the effectiveness of this work to the EU Council of Ministers in
2012. In addition, the conclusions urged the Commission to prioritise efforts to reduce alcohol-related harm
within the EU zone after 2012 as well.
Sweden has also played a key role in the process
leading to the adoption by the World Health Assembly
of the first Global Alcohol Strategy in 2010. Sweden will
continue to push for implementation of this strategy.
• Active efforts to ensure compliance with the
WHO Framework Convention on Tobacco Control
Sweden is to actively support implementation of public
health based, restrictive tobacco policies in the EU and
internationally.
During the strategy period, Sweden should:
• participate in the development of guidelines and
protocols for implementation of the Framework
Convention on Tobacco Control
• press for stronger consumer protection and clearer
regulations when the EU Tobacco Products Directive is reviewed.
The WHO Framework Convention on Tobacco Control
greatly increases the prospects of protecting people in
Sweden and elsewhere from the social, economic and
health-related consequences of tobacco consumption,
tobacco production and exposure to tobacco smoke.
Efforts are under way to develop guidelines and protocols on the 38 articles in the convention with a view to
translating the convention text into practical action in
and between signatory states.
• More effective coordination and increased
prioritisation of Nordic cooperation in the ANDT
sphere
Sweden wants Nordic cooperation on EU and international ANDT issues to become more goal- and resultsoriented.
During the strategy period:
• a survey should be undertaken of current projects
and commitments within the framework of Nordic
cooperation
• a flagship project on alcohol, narcotic drugs and the
young should be launched as part of the EU Strategy
for the Baltic Sea Region and the Northern Dimension Partnership on Public Health and Social WellBeing.
Alcohol and narcotic drug abuse and increased binge
drinking and drug use among the young are pressing problems for many of the countries around the Baltic Sea.
As part of the EU Strategy for the Baltic Sea Region and
the Northern Dimension Partnership on Public Health
and Social Well-Being, a special working group has been
appointed to spearhead the development of a flagship
project focusing on young people, alcohol and narcotic
drugs. The aim of the project is to develop and disseminate methods for alcohol and drug prevention work at
national and local level. The aim is to complete and evaluate the project before the end of the strategy period.
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FOLLOW-UP AND EVALUATION
In addition to providing a framework for policy goals and priorities, the ANDT strategy is to establish a
structure for following up developments in the spheres
of consumption and abuse, medical and social harm, and
operations and measures.
Official statistics are already available in some parts
of the ANDT sphere. In addition, there are numerous
national, regional and local studies, data collections and
questionnaire-based surveys undertaken by agencies and
organisations. As a rule, comparisons between different
sets of data are impossible since these are drawn from
different sources, based on different methods and, in
some cases, different definitions of key terms and issues.
Representatives of municipalities, county councils and
non governmental organisations have made clear on a
number of occasions their desire for greater coordination
and long-term thinking on the part of national actors
so that they can develop their own procedures for data
collection and reporting. In 2010, an initial survey and
analysis was accordingly made of existing data collections in the ANDT sphere, as part of the Government’s
programme of measures for ANDT policy in that year.
The Government intends to continue developing and
coordinating these statistics and data collection activities.
The aim is to track developments in such areas as ANDT
consumption and harm, abuse, care consumption the
effects of different types of public input on the individuals concerned and their families. A further aim is to
facilitate economic evaluations within a comprehensive,
integrated perspective.
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The Government plans to propose a limited number
of key indicators for follow-up and evaluation of the
ANDT strategy. An initial baseline measurement to
gauge the extent of the ANDT problem will be conducted in 2011 in accordance with a follow-up and evaluation structure developed by a working group composed
of representatives of relevant agencies and the research
community.
During the coming strategy period, the aim is to
present appropriate organisational arrangements for
open comparisons, follow-ups and evaluations of ANDT
strategy objectives. A system for reporting in accordance
with EU and international agreements is also to be put
in place.
External evaluation
Previous national action plans for alcohol and drugs
policy were not evaluated externally. The Government’s
advisory committee on alcohol, narcotic drugs, doping
substances or tobacco (the ANDT Committee) has
drawn attention to the need for early external evaluation of future ANDT policies. Accordingly, the strategy
will be evaluated externally. The evaluation will focus on
two specific concerns: (i) the degree to which the stated
objectives have been met; and (ii) operational level and
quality. The national evaluation will also include an
international comparison to enable an assessment of the
extent to which changes at national and regional level
have been influenced by changes elsewhere in the world.
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Published by The ANDT Secretariat
The ANDT Secretariat is a coordination function for the Governments
work on alcohol, narcotics, doping and tobacco policy.
103 33 Stockholm